Director's Report to the National Advisory Council on Drug Abuse

February, 1998

Research Findings

Epidemiology, Etiology and Prevention Research

Monitoring the Future Study

Results from the 1997 Monitoring the Future Study were released on December 20, 1997 (Lloyd Johnston, et al.). Following are the most significant findings:

Use of marijuana, cocaine, opiates other than heroin, and alcohol in the lifetime increased from 1996 to 1997 among high school seniors, and lifetime marijuana use increased among 10th graders. More recent use (past year and past month) remained stable with few exceptions. Results for 8th graders provided a glimmer of hope, with no increases, and decreases in a few categories. Attitudes toward substance use were mostly stable between 1996 and 1997. Perceived risk of harm was mostly stable for students in all three grades. Encouraging results were found for 8th graders, with disapproval increasing for selected marijuana, cocaine, alcohol, and cigarette use indicators. All changes presented below are statistically significant.

Illicit Drug Use

• Lifetime use of marijuana/hashish increased from 1996 to 1997 among 12th and 10th graders. Seniors' rate of lifetime marijuana use is higher than any year since 1987 but well below the peak seen in 1979. Past year and past month rates for marijuana remained unchanged for 10th and 12th graders. However, daily marijuana use in the past month increased among seniors but decreased among 8th graders.

• Driven in large part by the rise in marijuana, lifetime use of any illicit drug increased among 12th graders. Past month use of any illicit drug decreased among 8th graders; past year aggregate drug use remained stable for each grade.

• Lifetime use of cocaine, both as crack and powder, increased among 12th graders to reach its highest level since 1990 (highest since 1989 for crack). No changes in cocaine use were found for other recency periods or other grades.

• Past month use of LSD increased among 12th graders between 1996 and 1997.

• Heroin use in the past year decreased from 1996 to 1997 among 8th graders.

• Other opiate use in the lifetime and the past year increased among seniors.

• Stimulant use in the past month increased among 12th graders, but use of these drugs in the past year and in the past month decreased among 8th graders.

• Past month use of tranquilizers increased among 10th graders but decreased among 8th graders.

• Use of inhalants, hallucinogens other than LSD, MDMA, ice, and barbiturates remained stable for each grade level and recency-of-use category.

Perceived Harmfulness, Disapproval, and Perceived Availability

• The percentage of 8th graders reporting "great risk" in trying marijuana once or twice decreased. Perceived harmfulness of trying heroin once or twice and taking barbiturates regularly decreased among seniors.

• Disapproval of smoking marijuana occasionally or regularly increased among 8th graders.

• Disapproval of taking cocaine powder occasionally increased among 8th graders.

• Perceived availability of LSD and barbiturates decreased among 10th graders, and perceived availability of amphetamines decreased for 8th and 10th graders.

Alcohol Use

• Alcohol continues to be used at unacceptably high levels. Lifetime and past-year alcohol use increased for 12th graders. However, having "been drunk" in the past month decreased among 8th graders.

• The percentage of 8th graders reporting "great risk" in having five or more drinks once or twice each weekend increased for 8th graders and decreased for 12th graders.

Use of Cigarettes and Smokeless Tobacco

• Between 1996 and 1997, seniors' use of cigarettes in the past month along with daily smoking in the past month increased. Daily cigarette use among seniors is at its highest level since 1979.

• Among 8th graders, daily smoking in the past month deceased, and smoking a half-pack or more cigarettes per day decreased.

• Disapproval of smoking one or more packs of cigarettes per day increased among 8th and 10th graders.

• Lifetime use and past month use of smokeless tobacco decreased among 8th graders.

Community Epidemiology Work Group (CEWG)

The 43rd biannual meeting of the CEWG was held in Phoenix, Arizona on December 9-12, 1997. The CEWG is composed of researchers from 21 metropolitan areas of the United States who meet semiannually to report on patterns and trends of drug abuse in their respective areas; emerging drugs of abuse; vulnerable populations and factors that may place people at risk of drug use and abuse; and, negative health and social consequences. Reports are based on drug abuse indicator data, such as morbidity and mortality information, treatment data, and local and State law enforcement data. Additional sources of information include criminal justice, correctional, medical and community health data, local and State survey information, and research findings from ethnographic studies. The following are highlights from the meetings:

• Cocaine: Crack cocaine continues to dominate as the Nation's primary illicit drug problem, but indicator data show a leveling off in many urban areas: cocaine-related deaths were stable or up slightly in 6 of the 8 areas where such information was reported; emergency department (ED) mentions increased* in only 3 of the 20 CEWG cities in the Drug Abuse Warning Network (DAWN); the percentage of treatment admissions for primary cocaine problems declined slightly or remained stable in 13 of the 15 areas where data were available; and prices remained stable or declined slightly in most areas. Supplies remain abundant in nearly every city. Cocaine continues to be frequently used in combination with other drugs in some cities, including heroin and marijuana in Atlanta and Philadelphia, and methamphetamine in Denver. Demographic data continue to show most cocaine users as older, inner-city crack addicts; only in Miami were any new using populations reported this period. [* DAWN comparisons are for 1994 versus 1996; they are included only when they are reliable at p< 0.05.]

• Heroin: Heroin overshadows cocaine in some indicators: it was the top-ranking ED mention in three cities, and it was the most common primary drug of abuse among treatment admissions in six areas. The rate of ED mentions per 100,000 increased significantly* in eight cities. Mortality, treatment, arrestee urinalysis, and price/purity figures were mixed, with increases in some cities, declines in others, and stable trends in others. In six CEWG cities, noteworthy percentages (®10 percent) of arrestees, both male and female, tested heroin-positive in the Alcohol and Drug Abuse Monitoring (ADAM) program.

  Injecting remains the most common route of heroin administrationÑparticularly in the West, but also in some eastern and midwestern cities. However, it is declining sharply in some cities. Snorting predominates in several eastern and midwestern cities. Smoking is increasing among treatment admissions in Hawaii, San Diego, San Francisco, Atlanta, and Denver. Younger heroin users tend to snort or smoke the drug. Overall, heroin users tend to be males, older than 35, but in some cities, qualitative and quantitative dataÐincluding mortality figures in Miami--indicate increases among those age 18Ð25. Those age 17 and younger still account for relatively few ED mentions or treatment admissions, but even the low numbers, in areas such as Dallas, Minneapolis/St. Paul, San Francisco, and Texas, are a cause for serious concern.

• Marijuana: Continuing the upward trend in many cities since 1992, marijuana ED rates increased significantly* in 9 CEWG cities and primary marijuana abuse as a percentage of treatment admissions increased slightly to moderately in at least 10 reporting areas since the previous reporting period. Marijuana is now the top-ranking primary drug in at least four areas, and it accounts for substantial proportions (>20 percent) of nonalcohol admissions in at least three others. Among adult male arrestees, marijuana now exceeds cocaine as the most frequently detected drug in eight of the CEWG cities in ADAM; moreover, in each of the seven CEWG cities where ADAM tests juvenile males, the percentage of positive urinalyses is much higher for juveniles than for adults. Treatment demographics have similarly become increasingly youth dominated: the <17 age group now accounts for the largest percentages of marijuana admissions in at least eight areas. That age group also accounted for 20 percent or more of marijuana ED mentions in seven of the CEWG cities in 1996. All age groups, however, are substantially represented in all indicators, both qualitative and quantitative. Youth often consume marijuana with malt liquor. In some cities, joints or blunts are also dipped in PCP, codeine cough syrup, or embalming fluid; sometimes they contain crack or cocaine HCl, or they are laced with heroin.

• Stimulants: Except for ED mentions, methamphetamine indicators--mortality, treatment, and arrestee urinalysis--and ethnographic research show increases in the West, where the problem has been historically centered. Recent ADAM data show increases** in all the western CEWG cities. San Diego mortality figures also show increases, as do treatment figures in Denver, Los Angeles, and San Francisco. Methamphetamine is the most common primary drug among treatment admissions in San Diego and Hawaii, and it equals heroin as the number-one drug in Arizona. By contrast, ED rates declined significantly by 30-40 percent* throughout the West. They also declined* in Philadelphia, but the numbers are much lower there. The only city with a significant increase* was Minneapolis/St. Paul, but, again, the numbers are sharply lower than in the West. Smoking has recently overtaken inhalation as the primary route of administration in San Diego and Los Angeles. "Ice" smoking also predominates in Hawaii, and it is increasing in Denver and San Francisco. Injecting, however, still predominates in Denver, San Francisco, and Texas. In San Francisco, methamphetamine remains widespread among the gay and club scenes. Denver drug dealers sometimes cut crack or heroin with methamphetamine. Elsewhere in the country, methamphetamine appears in indicators in Minneapolis/St. Paul and in the rural areas surrounding St. Louis; availability is reported in Atlanta and New Orleans; and it is associated with the club or rave scenes in Boston, Baltimore, Miami, and New York City. [**ADAM comparisons are for first half of 1996 versus first half of 1997.]

  Methylenedioxymethamphetamine (MDMA or "ecstasy") availability is reported in 12 CEWG areas, primarily as a club drug at raves and dance parties. Increases are reported in Boston and Miami. Ephedrine-based products remain a major concern, with products such as "herbal ecstasy" widely available at convenience stores and truck stops in many CEWG areas, including Minneapolis/St. Paul and Arizona. Methylphenidate (Ritalin) abuse is reported among school-aged adolescents in Boston and Washington, DC, and it is the drug of choice for some stimulant users in Chicago. Seizures of khat, a flowering evergreen shrub also known as "qat" or "Somali tea," continue in Minneapolis/St. Paul.

• Depressants: Gamma-hydroxybutyrate (GHB) has been involved in poison control cases in Boston, Miami, and Texas, and is suspected in deaths in Miami; it is also part of the club scene (but not reported as a significant problem) in Baltimore, Honolulu, New York City, and areas of New Jersey; in Atlanta, it has become common as a synthetic steroid. Another club drug, ketamine ("Special K" or "Vitamin K"), is available in Boston (where youth both smoke and inject it), Honolulu, Miami, Minneapolis/St. Paul (where adolescents and young adults snort it and sometimes sprinkle it on tobacco or marijuana), New York City (where recent legislation has classified it as a controlled substance), and Washington, DC. Flunetrazepam (Rohypnol) availability has been sharply curtailed in Miami since State and Federal legislative measures were enacted. In Texas, however, it continues to be reported by treatment admissions, especially youth, in border areas. It continues to be reported in "date rape" incidents in Atlanta, Minnesota (where large quantities have been seized), and the Washington, DC, area; and it is used as a club drug in Atlanta and Honolulu. It has received media attention in some cities, such as San Diego and Seattle, but is not a widespread problem there. Clonazepam (marketed as Klonopin in the United States and Rivotril in Mexico), is sold and abused as flunetrazepam in Miami; on the Texas-Mexico border, juveniles widely use it in combination with beer, just as they had used flunetrazepam before the import ban. Opiate addicts use it to enhance the effects of methadone in Atlanta, Boston, and Minneapolis/St. Paul (where availability has declined).

• Hallucinogens: Lysergic acid diethylamide (LSD) is reportedly available in many CEWG cities and prices have become somewhat lower. However, indicators are declining in most areas. Rates of LSD-related ED mentions declined* in every CEWG area with the exception of San Diego and New Orleans. Similarly, phencyclidine (PCP)-related ED mentions declined* in six CEWG cities, but rose slightly in three. Primary hallucinogen users generally continue to constitute small percentages of total treatment admissions. Most hallucinogen users are young, suburban and middle class. In numerous areas, such as Chicago, Philadelphia, St. Louis and Texas, PCP is frequently used in combination with other drugs, primarily marijuana. In Boston and Seattle, LSD and other hallucinogens are often regarded as club drugs and used in the rave scene.

Behavioral Self-Regulation and Liability to Substance Abuse

Researchers at the Center for Education and Drug Abuse Research (CEDAR) investigated behavioral self-regulation (BSR) as a salient component of substance abuse liability. Three dimensions of childhood behavior were used to create a dimensional model of BSR: inattention, impulsivity/ hyperactivity and aggressivity. Multiple measures and multiple informants were used to develop indices of the three traits in a sample of 10-12 year old sons of substance abusing fathers (high risk (HR); n = 180) and normal controls (low average risk (LAR); n = 200). Informants included mothers, boys and their teachers. The results confirmed the presence of a first-order latent trait of BSR. HR boys had significantly poorer scores on BSR than LAR boys. Concurrent validity of the BSR trait scores was supported by significant associations with measures of family dysfunction, deviant peer affiliations and poor school performance. These latter problems are commonly prodromal to substance abuse. Predictive validity of the (poor) BSR trait baseline scores (age 10-12 years) was supported at 2 year follow-up by significant associations of poor BSR scores with magnitude of deviant peer affiliations; trends toward significance were found for family dysfunction and poor school performance. Taken together, these results confirm and extend previous findings which indicate that poor BSR is prodromal to substance abuse. Dawes, M.A., Tarter, R.E., and Kirisci, L. Behavioral Self-Regulation: Correlates and Two Year Follow-ups for Boys at Risk for Substance Abuse. Drug and Alcohol Dependence, 45(3), pp. 165-76, 1997.

The Emergence of Narcotic Addict Types and Prediction of Addiction Career Outcomes

Based on the retrospective self-reports about activities, perceptions, and experiences in early adolescence (12-14 years), researchers classified 255 narcotic addicts into four distinct groups using risk factor information from five descriptive domains: family, peer deviance, personal deviance, psychological status, and protective factors. The four groups (Marginal Deviants, Socially Damaged, Early Drug Abusers, and Behavioral Deviants) were differentiated primarily by the extent of early drug use, other behavioral deviance, and family dysfunction. The predictive utility of the typology was examined in terms of outcome over the first 10 years of the addiction career, including age at first narcotic addiction, amount of time incarcerated, and percentage of time addicted while in the community. Nine of 10 risk factors were statistically significant in differentiating addicts from nonaddicts. Narcotic addicts, as adolescents, were more likely to be characterized by greater family, peer, personal, and emotional difficulties and to be less protected from negative influences in their lives than were never-addicted individuals from the same neighborhood. The extent of preaddiction deviance during adolescence was the key dimension in differentiating types in relation to outcome. And, although family dysfunction was a prominent feature in classifying individuals who were comparatively low in deviance, this characteristic added little in the way of predictive relevance to the outcome measures examined. Nurco, D. N., et al. The Early Emergence of Narcotic Addict Types. Am. J. Drug Alcohol Abuse, 23(4), pp. 523-542, 1997.

High Prevalence of Sexual and Drug Use Risks Found in Drug-Using Women Who Have Sex With Women

Researchers analyzed the HIV-related risks of women IDUs and crack cocaine users who have sex with women. Between 1992-1994, 3,856 women were recruited from street settings in 19 U.S. cities participating as sites in NIDA's Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program. This analysis focused on data from 231 women who reported female sex partners in the 30 days before interview. In the 30 days before interview, 53% of the women had shared syringes and 66% had shared injection supplies. Only 11 women (6%) always used barrier protection while giving oral sex to women and 5 (3%) while receiving oral sex from women in the 30 days before interview. Fifty percent of the women reported sex with men as well as women in the previous 30 days, but only 26%-30% of the women who had sex with men used barrier methods to protect themselves from acquiring or transmitting HIV or other STDs. Having sex with men was predicted by commercial sex work, but not by self-identifying as a "lesbian." Differences in risk perception were significant between women who reported varying sexual risks, but not significant between women who reported varying injection-related risks. There is a high prevalence of risky sex and drug behaviors among drug using women who have sex with women, indicating a need to increase prevention efforts aimed toward this risk group. Kral, A.H., Lorvick, J., Bluthenthal, R., and Watters, J. HIV Risk Profile of Drug-Using Women Who Have Sex With Women in 19 U.S. Cities. J. AIDS, 16: pp. 211-217, 1997.

Precursors and Consequences of Gang Membership and Delinquency

Social scientific knowledge about youth gangs and how their members differ from nongang youths is limited and controversial. Knowledge of the etiology of gangs and the temporal relationship between gang membership and criminal behavior is especially limited. This study examines the relationship between gang membership and delinquency using self-report data from a survey of youths. This model-based study was conducted to explain gang membership in a population of 11,000 secondary school students in Colorado. Three models that can account for gang membership were tested: selection, social facilitation, or enhancement. Lower self-esteem, lower perceived academic ability, lower psychosocial health, and weaker bonds with institutions preceded gang membership which supports a selection model. Furthermore, greater drug use, greater delinquency, greater fear of harm, and being armed were both precursors and consequences of gang membership (facilitation and selection models). "Wannabes" were positioned half way between nonmembers and members and had the lowest level of self-esteem of any group. Being in a gang actually seemed to improve the self-esteem of the members, at least initially. Findings were consistent with theories that gang membership results from a lack of social integration. Dukes, R.L., Martinez, R.O., and Stein, J.A. Youth & Society, 29, pp. 139-165, 1997.

Alcohol Expectancies as Potential Mediators of Parent Alcoholism Effects on the Development of Adolescent Heavy Drinking

Children of Alcoholics (COAs) are at heightened risk for early onset of alcohol use, for heavy drinking, and for alcohol-related impairment. However, little is known about the mediating mechanisms that account for this risk. In a study of adolescents' expectancies about alcohol effects as potential mediators of their growth over time in heavy drinking, participants (n=428) were from an ongoing longitudinal study of parent alcoholism and data were collected in three annual in-person interviews with adolescents and their parents. Latent growth curve modeling analyses showed that COAs started the study at higher levels of heavy drinking and increased their heavy drinking at a steeper rate than did non-COAs over the course of the study. However, expectancies about alcohol effects could not explain these parent alcoholism effects. Although expectancies were related to adolescents' initial drinking levels, they did not prospectively predict growth over time in adolescent alcohol use. Thus, other mediating mechanisms (e.g., personality, parent and peer socialization) are necessary to explain parent alcoholism risk for escalation in heavy drinking during adolescence. Colder, C.R., Chassin, L., Stice, E., and Curran, P. Journal of Research on Adolescence, 7, pp. 359-374, 1997.

Sequence of Drug Use among Serious Drug Users: Typical vs Atypical Progression

The "typical" sequence of drug use onset identified in previous studies (alcohol, then marijuana, followed by other illicit drugs) was found to be much less prevalent among serious drug users than in samples of high school students. Sequence of drug use was examined in a secondary analysis of two samples of serious drug users: one of 152 men and one of 133 women. The data were collected in ethnographic studies of adult drug users and distributors in New York City between 1984 and 1987. The proportions of drug users following specified patterns of drug use onset were compared to proportions obtained in previous research in samples of high school youth, and serious drug users. Only 33% of the serious drug users followed the typical sequence, compared to 75-93% of subjects in previous studies of high school students. The serious drug users were more likely to have used marijuana before using alcohol, and more likely to have used other illicit drugs before using marijuana. In addition, atypical sequencing was associated with earlier initiation of the use of illicit drugs other than marijuana and greater lifetime drug involvement. These findings suggest that for a large number of serious drug users, marijuana does not play the role of a gateway drug. Prevention efforts that focus on alcohol and marijuana may be of limited effectiveness for youth who are at risk for serious drug abuse. Mackesy-Amiti, M.E., Fendrich, M., and Goldstein, P.J. Drug and Alcohol Dependence, 45, pp. 185-196, 1997.

Violence, Suicidality, and Alcohol/Drug Use Involvement in Adolescent Females with a Psychoactive Substance Use Disorder and Controls

This study had three aims: (1) to determine the relationship between behavioral dysregulation, negative affectivity, and familial impairment with violence and suicidality (i.e., severity of ideation and attempts) in a sample of adolescent females with a psychoactive substance use disorder and controls; (2) to determine whether these relations are mediated by internalizing (depression/anxiety) and externalizing (nonviolent antisocial behavior) symptomatology; and (3) to determine whether severity of alcohol/drug use involvement moderates the relations between the mediating variables with violence and suicidality. Multiple behavioral, psychiatric interview, and self-report measures were used to index behavioral dysregulation, negative affectivity, familial impairment, internalizing and externalizing symptomatology, and violence and suicidality in 161 14- to 18- year old adolescent females with a psychoactive substance use disorder and in 80 controls. Structural equation modeling was used to determine the proposed relations. Results indicated that behavioral dysregulation, negative affectivity, and familial impairment were related to violence, whereas only familial impairment was related to suicidality. Internalizing symptomatology mediated the relation between familial impairment and suicidality, and was related to violence, where as externalizing symptomatology mediated the relations between behavioral dysregulation, negative affectivity, and familial impairment with violence. Severity of alcohol/drug use involvement did not moderate the relations between internalizing or externalizing symptomatology with suicidality or violence. Nevertheless, the relation between internalizing symptomatology and suicidality was stronger in females with a greater degree of alcohol/drug use involvement, compared with those with a milder degree of involvement. Therefore, from a prevention standpoint, behavioral dysregulation, negative affectivity, familial impairment, as well as internalizing and externalizing symptoms, may serve as clinical "points of intervention" for altering the development of violence and suicidality in high risk and substance abusing youth. Mezzich, A.C., Giancola, P.R., Tarter, R.E., Lu, S., Parks, S.M., and Barrett, C.M. Alcoholism Clinical and Experimental Research, 21 (7), pp. 1300-1307, 1997.

Associations Between Attention Deficit Hyperactivity Disorder (ADHD) and Psychoactive Substance Use Disorders (PSUD)

In a sample of siblings of ADHD and non-ADHD probands, ADHD, conduct disorder, anxiety disorders, and male gender in the sibling were associated with higher rates of PSUD. There was also a statistical interaction between ADHD and conduct disorder in which nearly all siblings with both disorders had PSUD and a particularly early onset of that disorder. Using DSM-III-R structured diagnostic interviews and blind raters, a four-year follow-up of siblings from ADHD (N=152) and control families (N=117) was conducted. The mean age of the siblings was 17.3 (range 9 to 41) and roughly half were males. Information on PSUD was obtained in a standardized manner blind to the proband's clinical status. Cox proportional hazards models evaluated baseline diagnoses of ADHD and other psychiatric disorders (conduct, anxiety, and mood) as potential predictors of PSUD. These Cox analyses simultaneously controlled for confounding variables such as age, gender, intactness of family, and SES. These findings linking ADHD and PSUD could have significant public health significance. Since ADHD is a prevalent, childhood-onset disorder that is often characterized by impulsive behavior, it could represent a large group of youth at high risk for illicit drug use. Considering that the earliest age at onset of PSUD in our sample was 12 years and that the latest age at onset of ADHD is 7 years, there may be a window of several years where prevention and early intervention efforts could be targeted. Milberger, S., Biederman, J., Faraone, S.V., Wilens, T., and Chu, M.P. American Journal on Addictions, 6, pp. 318-329, 1997.

A Test of Socioeconomic Status As A Predictor of Initial Marijuana Use

The current study examined the effects of socioeconomic status (SES) on adolescent marijuana use using data from a national longitudinal survey of subjects aged 11 to 17 (N = 1,725). Both direct and indirect measures of SES (e.g., Hollingshead's measure of SES, urbanicity, neighborhood problems) were used to determine the extent to which SES predicts marijuana use among adolescents. For males, this study found a nonlinear relationship between the Hollingshead measure and marijuana use that had not been identified in previous research. For females, the Hollingshead measure was insignificant when alcohol use and having friends who use marijuana were added to the model. This finding suggests that the effects of SES on marijuana use are mediated by alcohol use and friends' use of marijuana. Weekly alcohol users were much more likely than nonusers to initiate marijuana use for both males and females. Other significant variables for both sexes included having a job, having friends who use marijuana, and having used some alcohol in the past year. For males, grade point average (GPA), commitment to friends, urbanicity, time spent with friends, and peer strain were also significant predictors of initial marijuana use. For females, prior victimization and low school aspirations were significant. In sum, these findings suggest that psychosocial risk factors for marijuana use are substantially different for males than for females and that future researchers need to test for nonlinear relationships between SES and adolescent substance use. Miller, D.S., and Miller, T.Q. Addictive Behaviors, 22 (4), pp. 479-489.

Risk and Protective Factors as Predictors of Adolescent Alcohol Involvement and Transitions in Alcohol Use: A Prospective Analysis

Determinants of initial alcohol use may differ from predictors of accelerated or problematic consumption. Social influences may be strong predictors of initial drinking; however, later stages of problem drinking may be linked developmentally to intrapersonal deficits. This study prospectively examined the influence of chronic and changing risk and protective status in predicting adolescent alcohol involvement and transitions in alcohol use. Data were obtained from a three-wave cohort (N=823) of 8th- 10th grade nonintervention students participating in a school-based drug abuse prevention trial. Cognitive, attitudinal and social influence measures were dichotomized using empirical cut-offs to designate risk or protective status. Using a conceptually based assignment scheme, additive risk indices were created assessing chronic (averaging across time) and changing features of competence, psychological and interpersonal functioning, cognitive-affective and social influences. Three chronic and change protective indices were created tapping competence, psychological, and interpersonal functioning. Controlling for initial drinking and gender, chronic risk for social influence and psychological functioning and increased risk for social influences and competency predicted subsequent drinking behavior. Chronic psychological protection attenuated subsequent drinking. Using categorical measures of drinking behavior to designate nonuse, experimental or moderate-heavy use, chronic social influence and competency risk were associated with an increased likelihood of accelerated drinking, whereas improved psychological functioning diminished the likelihood of increased drinking behavior. Findings underscore the need for implementing prevention strategies that reinforce developmentally appropriate skills and enhance personal competence and psychological functioning as effective barriers against initial and more problematic alcohol use. The unique contribution of protective forces also underscores that risk reduction and protection enhancement are complementary processes and are both required to offset social influences for alcohol consumption. Scheier, L.M., Botvin, G.J., and Baker, E. Journal of Studies Alcohol, 58, pp. 652-667, 1997.

High Prevalence of Hepatitis C Found in Alaskan Drug Users

To identify the prevalence of and predictors for hepatitis C virus (HCV) among not-in-treatment drug users in Anchorage, Alaska, researchers recruited 500 men (71%) and women (29%) from nonclinical settings to participate in structured interviews (i.e., NIDA's Risk Behavior Assessment) and to be tested for HIV and HCV. The mean age of the sample was 35 years; 48% were White, 29% African American, and 17% American Indian/Alaskan Native. Ninety-two percent reported smoking cocaine in the past 30 days, and 42% reported injecting drugs in the past 30 days (with a mean number of times injected in the last month of 18.6). There was a significant bivariate association between HCV positivity and injection drug use status; positivity among those reporting only injection drug use was very high, at 81%. Risk factors for HCV were drug injection in the past 30 days, ever having injected cocaine, ever having used speedball, ever having used heroin, number of days in jail, and number of sex partners in the last 30 days. The researchers note that although Anchorage is a small city in a rural state, the prevalence of HCV there is as high as it is in major U.S. metropolitan areas, suggesting that geographic location may not define differences in risk. In addition, recent reports indicate a high potential diffusion of blood-borne pathogens into rural American Indian/Alaskan Native populations in association with regular migration between rural and urban areas. This study demonstrates that, with the prevalence of HCV among drug injectors in Anchorage being so high, early interventions are critical to prevent persons at risk from acquiring and spreading the infection. Fisher, D.G., et al. Hepatitis C Virus Infection among Alaskan Drug Users. Amer. J. Public Health, 87(10): pp. 1722-1723, 1997 (letter).

Predicting Dropping Out of High-School Based on Data from a 19-Year Longitudinal Study of Family Lifestyles

In this study, nested latent-variable causal models were contrasted to compare the direct and indirect relationships of distal family and child and proximal adolescent factors to dropping out of high school. The sample included 194 conventional and nonconventional families that have been participating in a 19-year longitudinal study, the Family Lifestyles Project. The findings showed that dropping out of high school is a multiply-determined process, with early influences beginning in childhood, that involves family as well as child and adolescent factors. Among the hypothesized predictors of dropping out were early child drug exposure and adolescent drug use. Early child drug exposure by adult models directly predicted later adolescent drug use which in turn predicted more high school dropout. The indirect effect of early drug exposure on later dropping out was also significant. Early family nonconventionality when combined with a higher commitment to lifestyle values was associated with a lower probability of dropping out. Garnier, H.E., Stein, J.A., and Jacobs, J. American Educational Research Journal, 34, pp. 395-419, 1997.

Drug Treatment Careers: A Conceptual Framework and Existing Research Findings

A treatment careers perspective applies a longitudinal dynamic approach to identify and understand key factors influencing the development of, and transition in the course of, drug dependence and its treatment. This paper reviews and discusses relevant research issues and findings on treatment seeking, utilization and resistance, entry and reentry, engagement and retention, client treatment matching, and outcomes. Key findings include high resistance to entering treatment by many drug users, late development of treatment careers relative to addiction and criminal careers, short duration of most treatment episodes, cumulative and facilitative effects of treatment experiences, and beneficial effects of matching clients to treatment. Overall, longer periods of treatment are associated with larger and longer periods of prosocial functioning following treatment. In conclusion, treatment has been shown to be far less costly to society than incarceration or the drug-related antisocial activities of untreated dependent users. Hser, Y.I, Anglin, M.D., Grella, C.E., Longshore, D., and Prendergast, M. Drug Treatment Careers: A Conceptual Framework and Existing Research Findings. Journal of Substance Abuse Treatment, 14 (3), pp. 1-16, 1997.

Standardized Test Performance of Children with a History of Prenatal Exposure to Multiple Drugs/Cocaine

Children with histories of prenatal polydrug exposure that included cocaine scored significantly lower on standardized test measures of language development (Receptive and Expressive subtests of the Sequenced Inventory of Communicative Development-Revised) than nonexposed children. Clinically, 45.8% of the children in the drug-exposed group qualified for early intervention services. Significant differences between groups were also noted on the Bayley Scales of Infant Development. No differences were found on the Peabody Picture Vocabulary Test - Revised. Each group had 24 children, age 14 to 50 months, and included 13 males and 11 females. All children were living in stable, drug-free environments (foster/adoptive/natural homes). Tests were administered by a certified speech-language pathologist and language samples were taken from 30 minute videotaping sessions showing the child and caregiver playing. Results indicate that, due to the cumulative effects of prenatal history, children with histories of prenatal drug exposure should be considered at risk for language delay. Johnson, J.M., Seikel, J.A., Madison, C.M., Foose, S.M., and Rinard, K.D. Journal of Communication Disorders, 30, pp. 45-73, 1997.

Intra-Family Substance Use

Analyses that specifically model the within-level and between-level covariance matrices are used to examine family levels of substance use and predictors of family substance use. Data from 1135 participants and 430 families (430 target adolescents, 137 siblings, and 568 parents) were included in the analyses, with family cluster sizes ranging from two to five. Adolescents had a mean age of 16.15 years. Between-level variation in substance use scores represented approximately 38% of the total variation in substance use scores, illustrating the importance of a common environment, such as the family, in accounting for levels of substance use. Contextual variables, or family-level predictors included marital status, SES, and biological relatedness. Intra-class correlation coefficients for biologically related families were higher for alcohol, cigarettes, marijuana, and illicit drugs, than they were for non-biologically related families with all three family-level variables significantly predicting the between-level substance use variance. In general, those families characterized as more economically disadvantaged, of a single parent nature, and non-biologically related, had higher family-levels of substance use. Duncan, T.E., Duncan, S.C., Hops, H., and Alpert, A. Drug and Alcohol Dependence, 46, pp. 167-180, 1997.

Latent Variable Modeling of Longitudinal and Multilevel Substance Use Data

Multilevel Latent Growth Modeling (MLGM) was used to analyze longitudinal and multilevel data for adolescent and parent substance use measured at four annual time points. An associative LGM model was tested for alcohol, cigarette and marijuana use with a sample of 435 families (435 target adolescents, 203 siblings, and 566 parents). Adolescents (targets and siblings) had a mean age at T1 of 13.69 years. Sufficient homogeneity in substance use within families was found, with the proportion of between variation, or intraclass correlation, for the four repeated measures, ranging from .26 to .30 for alcohol, .26 to .29 for cigarettes, and .28 to .33 for marijuana. Results revealed a significant upward trend in the development of alcohol, cigarette and marijuana use among families. The shapes of the family-level developmental curves for each substance were also strongly related. Younger family members had higher initial levels of use and developed in their use of substances at a faster rate than older family members. Males had higher levels of alcohol use than females. Single and step-parent families had higher family-levels of substance use, whereas families characterized as less educated and more economically disadvantaged had higher levels of cigarette use and developed in their use of marijuana at a greater rate. Duncan, T.E., Duncan, S.C., Alpert, A., Hops, H., Stoolmiller, M., and Muth, N. B. Latent Variable Modeling of Longitudinal and Multilevel Substance Use Data. Multivariate Behavioral Research, 32, pp. 275-318, 1997.

Effects of Community Intervention on Drug Use among High Risk Adolescents

In a study of the second site for the Midwestern prevention project (Indianapolis), 3 years effects of a multi-component community-based drug abuse prevention program were evaluated on a panel sample of 3400 students from 57 junior high schools who were randomly assigned to a program or control condition. The study, which has already shown sustained effects on delaying drug use onset and decreasing population-based use prevalence, evaluated effects on decreasing drug use among baseline users, a high risk sample. Results showed significant effects by decreasing drug use among users for tobacco, alcohol, and marijuana. The study counters a commonly held belief that primary prevention works only with non-users or occasional users. Chou, C.P., Montgomery, S.B., Pentz, M.A., Rohrbach, L.A., Johnson, C.A., Flay, B.R., & Mackinnon, D. Effects of a Community-Based Prevention Program on Decreasing Drug Use in High Risk Adolescents. American Journal of Public Health, In Press.

Assessing Drug Use in the Workplace

A study intending to provide information on the accuracy and validity of different forms of drug use prevalence assessment in the workplace, and to suggest ways in which the methods of workplace drug use prevalence assessment could be improved, was conducted. A comparison of self-report, urinalysis, and hair analysis was made on 928 steel plant workers and the findings indicated that combining data from self-reports and bioassays resulted in a drug use prevalence rate that was approximately 50% higher than the prevalence rate produced by self-report alone. Among four different forms of self-report -- individual interview in the workplace, telephone interview, group-administered questionnaire in the workplace and individual interview off the worksite -- all produced very similar prevalence rates, except for the group condition, which resulted in rates that were roughly half of those of the other self-report methods. Cook, R.F., Bernstein, A.D., and Andrews, C.M. Assessing Drug Use in the Workplace: A Comparison of Self-Report, Urinalysis, and Hair Analysis. In Harrison & Hughes (Eds.) NIDA Research Monograph #167, The Validity of Self-Reported Drug Use: Improving the Accuracy of Survey Estimates. Rockville: NIDA, 1997.

Latent Transition Analysis Shows Caffeine Use is Correlated to Initiation of Drug Use

This chapter introduces a relatively new methodology, latent transition analysis (LTA) and demonstrates its usefulness in substance abuse prevention research. LTA can be used to evaluate various aspects of stage-sequential models. It can help the user to assess whether a hypothesized set of stages is a realistic representation of a data set, and can be used to compare different models of the stage transition process. LTA is a latent variable model for longitudinal panel data.. It was measured in 7th grade and again in 8th grade students. Using a cross-validation procedure developed for LTA, the model accepted was an 8-stage model: "no use", "alcohol only", "tobacco only", "alcohol + tobacco", "alcohol + drunk", "alcohol, drunk, advanced", "alcohol, tobacco, advanced", and "alcohol, tobacco, drunk, advanced". In this study, caffeine risk was defined as low through high use. Results showed that those in the "high risk" group based on caffeine use at 7th grade, by any definition of caffeine risk, were 1.5 to 2.5 times less likely than those in the "low-risk" group to be in the "no use" stage in 7th grade. Those in the "high risk" group were also 2.4 to 3.9 times more likely than those in the "low risk" group to be in the highest drug use stage at 7th grade. Finally, those in the "high risk" group were 1.2 to 1.9 times more likely than those in the "low risk" group to transition out of the "no use" drug stage between 7th and 8th grades. The results of this study suggest that high use of caffeine is associated with an increased probability that an individual will initiate the onset process. Collins, L.M., Graham, J.W., Rousculp, S.S., & Hansen, W.B. Heavy Caffeine Use and the Beginning of the Substance Use Onset Process: An Illustration of Latent Transition Analysis. In K. Bryant, M. Windle, and S. G. West (Eds.) The Science of Prevention: Methodological Advances from Alcohol and Substance Abuse Research. pp. 79-99. Washington, D.C.: American Psychological Association, 1997.

Role of Acculturation in Substance Use among Latino Adolescents

In a study of at-risk multi-ethnic middle school students, 448 Latino adolescents ranging in age from 11 to 14 completed measures of social influence variables (attitudes, subjective norms, and perceived behavioral control), intentions toward substance use, and acculturation. Language use/exposure was not significantly related to the social influence variables nor intentions to use alcohol, cigarettes, and marijuana. However, increased interaction with non-Latino peers was positively related to attitudes and perceived peer norms against substance use. In addition, for those of high acculturation, perceived normative expectations against substance use by referent others appeared to play a key role in future substance use. For those of low acculturation, attitudes against substance use appeared to have a stronger impact on avoidance of future substance use. The findings of this study are relevant to increasing the effectiveness of substance use prevention programs targeting Latino adolescents. Interventions that address risk and protective factors of substance use in Latino adolescents may consider measuring various components of acculturation. Carvajal, S.C., Photiades, J.R., Evans, R.I., & Nash, S.G. Relating a Social Influence Model to the Role of Acculturation in Substance Use among Latino Adolescents. Journal of Applied Social Psychology, pp. 1617-1628, 1997.

Consequences of Sexual Assault

Data were obtained from a nonclinical sample of 1,121 Mexican American and White non-Hispanic adolescent females. The three hundred and three participants who reported being sexually assaulted were compared to the 793 who reported no history of sexual assault on a number of psychosocial characteristics. Although rates of sexual assault differed across ethnicity, ethnicity did not influence the relationship between sexual assault and psychosocial characteristics of victims. Results indicated that sexual assault victims reported more emotional distress, more social isolation and more deviant behaviors than non-victims. Sexual assault victims also reported poorer school adjustment, were more like to affiliate with deviant peers, and were more likely to come from homes in which there was parental substance use and family conflict. Arellano, C.M., Kuhn, J.A., & Chavez, E.L. Psychosocial Correlates of Sexual Assault Among Mexican American and White Non-Hispanic Adolescent Females. Hispanic Journal of Behavioral Sciences, 19 (4), pp. 446-460, 1997.

Effects of a Family-Based Prevention Intervention

A number of family-related factors have been identified that contribute to the risk for or protection against initiation of substance use and other problem behaviors as children move from childhood into early adolescence. This article reports results from an experimental test of the effects of Preparing for the Drug Free Years (PDFY) on targeted parental behaviors. PDFY is based on the social development model; it seeks to reduce risks and enhance protection against early substance abuse initiation by improving patterns of parental behavior and family interaction. The sample consisted of economically stressed, rural Midwestern families. Consistent with hypotheses, the program increased proactive communications between parents and children. Specifically, following the program, intervention group mothers exhibited more proactive communications in general and in problem solving tasks and less negative interactions with their children than did the control group mothers. Intervention group fathers exhibited significantly more proactive communications with children in problem solving situations than did the control group fathers. Kosterman, R., Hawkins, J. D., Spoth, R., Haggerty, K.P., & Zhu, K. Effects of ÔPreparing for the Drug Free Years' on Parenting Behavior and Family Interactions. Journal of Community Psychology, 25(4), pp. 337-352, 1997.

Program Evaluation Approaches for Prevention Data

Recent literature underscores the need for studies of family-based preventive interventions oriented toward public health. This article illustrates a program evaluation approach that is especially suitable to the study of family intervention outcomes in general populations. Thirty-three rural schools were randomly assigned to one of three conditions: the Preparing for the Drug Free Years Program (PDFY), the Iowa Strengthening Families Program (ISFP), and a minimal contact control group. Self-report and observational data collected for 523 families were used to develop measurement models of the three latent parenting constructs that included measurement methods effects. Analyses were conducted (a) to assure initial and attrition-related group equivalencies and (b) to assess school level effects. Structural equation models of the hypothesized sequence of direct and indirect effects for both PDFY and ISFP were then fitted to the data. All hypothesized effects were significant for both interventions. The discussion addresses the potential public health benefits of evaluation research on universal prevention interventions. Spoth, R., Redmond, C., and Shin, C. Direct and Indirect Latent Variable Parenting Outcome of Two Universal Family-Focused Prevention Interventions: Extending a Public Health-Oriented Research Base. Journal of Consulting and Clinical Psychology, In Press.

Young Adults' Drug Use: A 17 Year Longitudinal Inquiry of Antecedents

This longitudinal study examined the interrelation of personality and peer factors on young adults' drug use. This research also examined the influence of the interaction of personality and peer factors on drug use. The samples of 756 males and females was interviewed four times between the mean ages of 6 and 22. Personality attributes in childhood were related to peer factors in early adolescence which, in turn, were related to personality traits in later adolescence. These traits were linked with the selection of peers and, ultimately, drug use in young adulthood. Additionally, the adolescent and young adult domains had direct effects on young adults' drug use. Significant interactions indicated that a few protective childhood personality traits buffered the risk factor of the adverse effects of deviant peers in adolescence on young adults' drug use. The presence of protective characteristics from one domain in childhood enhanced the preventive effect of later protective traits from the other domain in young adulthood on drug use. Brook, J.S., Balka, E.B., Gursen, M., Brook, D.W., Shapiro, J., Cohen, P. Psychological Reports, 1997.

Cigarette Smoking in Young Adults: Childhood and Adolescent Personality, Familial and Peer Antecedents

Prior research has demonstrated a complex interplay of a number of distinct psychosocial risk factors as they relate to cigarette smoking in young adults. In addressing the risk factors associated with tobacco use by young adults, this study examined: (1) the identification of the specific childhood and adolescent risk factors; (2) the interrelation of personality, family, and peer factors and (3) the extent to which the behaviors related to tobacco use vary by developmental stage. Three models (independent, mediational, and interdependent) were hypothesized to examine the interrelation of these variables and their effects on young adult cigarette smoking. At initial data collection, mothers were interviewed about their children when they were between the ages of 1 and 10. Three subsequent interviews were conducted with the children when they reached adolescence and young adulthood. Results show support for the mediational model and are in accord with the family interactional framework conceptions, developed to examine the pathways that lead to adolescent legal and illegal drug use and other problem behavior. There was a sequence in patterning from parenting during early adolescence to personality and peer factors extending to late adolescent smoking, and culminating in adult smoking. More specifically, difficulty in the parent-child relationship was related to tobacco-prone personality characteristics. Using a developmental approach, a number of psychosocial measures were found to be related in both younger and older children. Nevertheless, some interesting developmental differences emerged. The findings suggest at least four possible targets for therapeutic or preventive intervention: the parent, the child, the adolescent, and the peer group. Brook, J.S., Whiteman, M., Czeisler, L.J., Shapiro, J., Cohen, P. The Journal of Genetic Psychology, 158 (2), pp. 172-188, 1997.

Assessing the Impact of the D.A.R.E. Program after Six Years

The long-term effectiveness of D.A.R.E. was assessed by contrasting drug use and other D.A.R.E.-related attitudinal latent variables among 356 12th-grade students who had received the program in the 6th grade with 264 others who did not receive it. A prior study of these subjects when they were in 9th grade had shown no significant differences. A follow-up survey in 12th grade assessed central D.A.R.E. concepts such as self-esteem, police bonds, delay of experimentation with drugs, and various forms of drug use. Although no relationship between prior D.A.R.E. participation and later alcohol use, cigarette smoking, or marijuana use in 12th-grade was found, there was a significant relationship between earlier D.A.R.E. participation and less use of illegal, more deviant drugs (e.g., inhalants, cocaine, LSD) in a development sample although not in a validation sample. Further analyses indicated that this effect was significant for the males and nonsignificant for the females. Findings from the two studies suggest a possible "sleeper effect" for D.A.R.E. in reference to use of harder drugs, especially among teenage males. Dukes, R., Stein, J.A., and Ullman, J.B. Evaluation Review, 21, pp. 483-500, 1997.

Factors which Moderate the Relationship between Parenting Practices and Children's Symptoms

A normative sample of 64 fourth and fifth grade boys, was used to assess the moderating effects of children's activity level and fear on relations between parenting practices and aggressive and depressive symptoms. Findings from multiple regression analyses showed that (a) poorly monitored active boys, and (b) fearful boys who were exposed to harsh discipline exhibited high levels of aggression. In addition, boys characterized by high fear who were exposed to harsh discipline or whose parents were extremely overinvolved showed elevated levels of depressive symptoms. These findings suggest that integrating children's individual differences with parenting models enhances our understanding of the etiology of childhood risk markers for later substance use. The results indicate that certain deficient parenting practices are likely to be associated with children's behavioral problems primarily when the children have certain temperaments high activity and high fear. Thus, intervention could more heavily emphasize altering these parenting practices (harsh discipline, poor monitoring) when specific children are high on these temperament features. Colder, C.R., Lochman, J.E., & Wells, K.C. The Moderating Effects of Children's Fear and Activity Level on Relations between Parenting Practices and Childhood Symptomatology. Journal of Abnormal Child Psychology, 25, pp. 251-263, 1997.

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